Should my child take stimulant medications for ADHD?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Trying to decide whether to give your child medications to treat attention deficit hyperactivity disorder (ADHD) can be confusing and even agonizing. Parents need to weigh the benefits of taking stimulants—improved performance at school and home—with any risks when deciding about medications. Consider the following when making your decision:
- You may want to have your child tested by a psychologist for any learning disabilities.
- You may want to try professional counselling, behaviour management, and social skills training before stimulants, especially if you think your child's symptoms are related to another condition or are mild.
- If your child's performance at school and his or her relationships are affected, you may want to consider stimulant medications because they are the most effective treatment for ADHD, resulting in a dramatic improvement in behaviour and other symptoms in about 70% of people with ADHD.1
- Stimulants will help curb symptoms of ADHD—hyperactivity, impulsivity, and inattention—but they will not solve all of your child's behaviour problems.
- Although short-term studies have shown stimulant medications are safe, long-term effects have not been studied. A recent 2-year study found that children grow almost 1.5 cm (0.5 in.) per year slower than those children who are not on medication, although it is possible that your child might catch up over a period of time.2
- You may want to try the new non-stimulant medication atomoxetine (Strattera) if stimulant medications are not effective or have lasting side effects.
Medical Information
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a common behavioural disorder that causes inattention, hyperactivity, and impulsivity. People with ADHD have a hard time concentrating, sitting still, and controlling their impulsive thoughts or behaviours. In addition, ADHD can lead to problems with memory and organization.
Behavioural symptoms begin early in childhood and lead to problems at school, at home, and with friends. Consequently, the child may develop low self-esteem or symptoms of depression if ADHD is left untreated.
What medications are used to treat ADHD?
The medications most often used to treat ADHD are stimulants, such as Ritalin, Concerta, Dexedrine, and Adderall XR. These medications affect the way the brain controls impulses, behaviour, and attention span. Some medications are short-term (last 4 hours) and others may last all day.
A nonstimulant medication called atomoxetine (Strattera) has been approved for ADHD. This medication may be prescribed if stimulant medications are not effective or have lasting side effects. Strattera is not a controlled drug, allowing phone refills. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on Strattera. They suggest parents, families, and other caregivers closely watch for warning signs of suicide in all people who take this medicine.3, 4 Health Canada and the FDA do not recommend that people stop using this medicine, but to watch for warning signs of suicide in those using it.
Other medications may be used to treat ADHD if stimulants have not been effective. Antidepressants (such as Wellbutrin) may be helpful. Antihypertensives (such as Catapres) can help control aggressive and impulsive behaviours in some people.
Stimulant medications with amphetamine, such as Adderall, that are used for the treatment of ADHD are approved by Health Canada for children age 3 and older. Stimulant medications with methylphenidate, such as Ritalin, are approved for children age 6 and older. A doctor may prescribe Ritalin for a child under age 6 based on the child's specific needs.
What are the side effects of these medications?
Side effects of medications used to treat ADHD are usually mild and temporary, lasting only a few weeks. The most common side effects of stimulants are decreased appetite, difficulty falling asleep, stomach ache, and headache. When the dose is lowered, these side effects usually fade quickly.
Although short-term studies have shown that stimulant medications are safe, long-term effects have not been studied. In a recent 2-year study, children who took stimulant medication grew almost 1.5 cm (0.5 in.) per year slower than those children not on medication. The study followed 540 youngsters with attention deficit hyperactivity disorder (ADHD) who were ages 7 to 9 at the start of the study. More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) and whether children taking these medications might catch up over a period of time.2 As with any medication, parents should balance the benefits their child might receive from these medications with any potential risks.
What are the risks of not treating ADHD?
When ADHD goes untreated, your child is at greater risk for poor school performance. Relationships with friends or family members may be troubled due to impulsive or aggressive behaviours. Peers often reject children with uncontrolled ADHD, which then leads to self-esteem problems for the child. It may be difficult for the child to learn appropriate social skills that help him or her be accepted by peers, teachers, and others. Some people with untreated ADHD have difficulty finishing school or keeping a job and difficulty with relationships as they become adults.
If you need more information, see the topic Attention Deficit Hyperactivity Disorder.
Your Information
Your choices are:
- Have your child take medication alone to improve ADHD symptoms.
- Have your child take medication along with counselling, behaviour management, social skills training, or other treatments to improve symptoms.
- Do not have your child take medication, and try to reduce impulsivity, inattention, and hyperactivity through other treatments such as behaviour management, education, and social skills training.
The decision about whether to have your child take stimulant or other medications for ADHD takes into account your personal feelings and the medical facts. It is important for parents to be honest with their child about the possible risks and benefits of the medicine.
Deciding about having your child take medications for ADHD Reasons to take ADHD medications Reasons not to take ADHD medications
- Your child is not able to control impulsive or aggressive behaviours, which are causing relationship problems.
- Your child is performing poorly in school due to inability to concentrate, focus, or sit still.
- You have tried other treatments such as behaviour management, but they have not helped.
- You are concerned that your child's self-esteem may be affected.
Are there other reason you might want to give your child medications to treat ADHD?
- Symptoms are sporadic and do not interfere with daily living or relationships.
- You want to try other treatment, such as social skills training or behaviour management.
- Your child is performing at or near grade level.
- You are concerned about the unknown long-term effects of taking medication.
Are there other reasons you might not want to give your child medications to treat ADHD?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about giving your child medication to treat ADHD. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
My child is able to maintain friendships. Yes No Unsure My child's school performance is average or above average. Yes No Unsure My child can sit still long enough to read a book. Yes No Unsure My child does not have a learning disability. Yes No Unsure My child has low self-esteem or seems to be depressed. Yes No Unsure My child is age 6 or older. Yes No NA* My child has been diagnosed with ADHD. Yes No NA My child is not able to make or keep friends. Yes No NA My child can follow through with most age-appropriate tasks I ask him or her to do. Yes No NA *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medications to treat ADHD.
Check the box below that represents your overall impression about your decision.
Leaning toward giving my child medications to treat ADHD
Leaning toward NOT giving my child medications to treat ADHD
Return to the topic Attention Deficit Hyperactivity Disorder.
| Author: | Carrie Henley Sabra L. Katz-Wise | Last Updated: August 31, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Mina Dulcan, MD - Child and Adolescent Psychiatry Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics | |
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